2018-475-E Finance - Piedmont Health Services Inc outside agency agreement

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DocuSign Envelope ID: CCFF6125- AA47- 438A- 98CA- B42519499D42 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION 2. AGENCY INFORMATION (Be Very Brief and Concise) Please provide the following information about your agency (2 pages OR LESS): a) Years in Operation, Date of Incorporation (Month /Year): 3/1970 b) Agency's Purpose /Mission (no more than a few sentences): Piedmont Health Services, Inc. (PHS) is part of the community's primary health care safety net for vulnerable and /or financially- disadvantaged residents. PHS' mission is: "to improve the health and well -being of the community by providing high quality, affordable and comprehensive primary health care. Our vision is a health community in which all people have timely access to quality health care." Like health centers nationally, PHS offers a sliding fee scale for services tied to the Federal Poverty Guideline for those who qualify. c) Types of Services the Agency Provides (bullet format): 1) Community Health Centers (10 sites, open to anyone, serves >40,000 individuals /yr.) • Sliding -fee, English /Spanish - bilingual medical care for individuals across the lifespan (e.g. well /preventive including family planning /prenatal care and acute /chronic illness management) with integrated behavioral health, on -site laboratory services, and 24 -hour access to medical advice; • Sliding -fee, English /Spanish - bilingual dental care for individuals across the lifespan (e.g. preventive, restorative, prosthodontic); • Pharmacy services, with seven on -site pharmacies available to any registered patient, with a full formulary of low -cost medications available through PHS' participation in the Federal 340B Drug Pricing Program and selected patient assistance programs; • Women Infant Child (WIC) Supplemental Nutrition Program, with services offered at four CHC locations, the Orange County Health Department, and on outreach to UNC Hospitals. • Health support services including care management, Medicaid and ACA Healthcare Marketplace eligibility assistance, and interpretation support. • Population health- specific programming varies by site including but not limited to refugee health; health care for the homeless; transgender health care; HIV /AIDs care, and school health. 2) Piedmont Health SeniorCare, a Program of All- Inclusive Care for the Elderly (PACE) (2 sites, open to PACE - eligible residents of Orange, Alamance, Caswell, Chatham, and Lee Counties, current enrollment is 273) • PACE is a nationally successful model of long -term, community -based geriatric care which seeks to maximize the independence and quality of life of the frail elderly who wish to age in place in the community and avoid nursing home institutionalization. • PACE is a voluntary option under the Medicare and state Medicaid programs open to individuals who are: age 55 years and older, declared nursing home eligible by the state (throughout the FL -2 process), live in a defined service area served by a PACE program, and capable of living safely at home with PACE supports at the time of admission to the program (7% of PACE participants nationally reside in nursing homes and continue to participate). Participants may dis- enroll at any time and resume traditional Medicare and Medicaid benefits. • As a PACE provider, PHS is fully "at risk," responsible for paying for the TOTAL care of participants, including all medically necessary primary, specialty and tertiary care (e.g. hospital, nursing home) and social support services for which it receives per member per month (PMPM) capitation from Medicare and Medicaid. • Most Piedmont Health SeniorCare services are provided directly by staff at two Adult Day Health Center locations in Burlington and Pittsboro where participants are typically transported several days a week to receive health monitoring, rehabilitative therapies, socialization activities and meals. Each participant is cared for according to an individual care plan which is monitored in on -going fashion by an interdisciplinary team of professionals including medical, nursing, rehabilitative therapies, nutrition, social work, and transportation staff. Agency Information 1/23/2018 11:00:54 AM Page 10 of 23